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Biomedical subjects

D M Becker

Publications and source records attributed to D M Becker.

At least 19 recordsLinked to original sources
PubMed1992

Case report: venous thromboembolism in AIDS.

Recently, the authors managed three patients with AIDS and venous thromboembolism. All three were active, ambulatory, and without known risk factors for pulmonary embolism or deep venous thrombosis. One patient had a low titer for IgG anticardiolipin antibody (1:13). Two had low normal values for free protein S, and the third patient had a very low value (5%). Clinicians caring for AIDS patients should be alert to the possibility that venous thromboembolism may complicate HIV infection.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Inferior vena cava filters. Indications, safety, effectiveness.

BACKGROUND: Preventing pulmonary embolization by interrupting vena caval flow has been attempted since 1893. Inferior vena cava (IVC) filters have been available for 20 years, and currently there are five filters commercially available in the United States (Greenfield filter, Titanium Greenfield filter, Simon-Nitinol filter, Bird's Nest filter, and LGM or Vena Tech filter) and two other filters under development (Amplatz filter and Günther filter). Although these devices are widely used, their clinical utility and safety have not been completely evaluated. Controlled clinical trials to determine the clinical role for IVC filters have not been attempted, but numerous case series describing the outcomes of the seven current filters have been published. We have systematically reviewed these studies to clarify what is known about the indications, safety, and effectiveness of IVC filters. METHODS: Using the MEDLINE database, all English-language publications since 1970 that included follow-up clinical information after filter insertion were reviewed and eight methodologic guidelines were employed to assess the scientific quality of the clinical information. RESULTS: Twenty-four case series were reviewed: 16 concerned the Greenfield filter (1632 patients), and eight dealt with newer designs (925 patients). Commonly noted methodologic problems included failure to report the initial extent of thromboembolic disease, incomplete description of the patient assembly process, and incomplete and potentially biased outcome assessment. Recurrent clinical pulmonary embolism was rare after filter placement, and only eight deaths from pulmonary embolism were reported. Filter complications were common but rarely life threatening; four (0.16%) deaths from filter complications were noted among the reviewed studies. Thrombotic complications following filter placement included insertion-site deep vein thrombosis and IVC obstruction. These events were rare, but they occurred with all filter types. CONCLUSIONS: Inferior vena cava filters appear to be effective in preventing recurrent pulmonary embolism. Despite the large published experience with IVC filters, many questions remain about their indications, safety, and effectiveness. Anticoagulant therapy, if not contraindicated, should be used in conjunction with filters. While there is no ideal filter, some situations call for specific filters. Filter selection and insertion require experience, modern angiographic technique, and collaboration between clinicians caring for patients and the interventional radiologists or surgeons inserting the device.

Anticoagulants↗
PubMed1992

A partnership with minority populations: a community model of effectiveness research.

This paper describes a community-based approach, including a partnership of an academic medical institution and a high-risk, urban, African-American population, directed at decreasing premature morbidity and mortality and enhancing health and functional status. The intervention approach is based on a model of community-based leadership and "ownership" of interventions and programs to enhance sustainability of effective approaches, and it follows specific stages to assure appropriate assessment and evaluation. Initial efforts were directed at the control of hypertension and were coordinated through decentralized mayor's stations in Baltimore, Maryland. This approach was successful in significantly enhancing control of hypertension and reducing related morbidity and mortality. Over time, an enhanced partnership has been coordinated through churches in the community and organized around a program entitled "Heart, Body, and Soul." Current efforts are directed at the major risk factors and preventable and/or controllable problems in the population, such as hypertension, smoking, obesity, diabetes, hyperlipidemia, and cervical and breast cancer. Key components include the training of neighborhood health workers to provide screening, counseling, monitoring, support, and follow-up; enhanced access to care; training of high school students as health counselors; and use of media to promote healthier life-styles.

Academic Medical Centers↗
PubMed1992

Optimal management of suspected lower-extremity deep vein thrombosis. An evaluation with cost assessment of 24 management strategies.

Traditionally, patients suspected to have lower-extremity deep vein thrombosis have undergone venography, which is invasive, is expensive, and may cause deep vein thrombosis in healthy individuals. Recent studies have shown the safety and efficacy of alternative noninvasive approaches that employ impedance plethysmography or real-time ultrasonography. We compared these tests using decision analysis to model the consequences of 24 different management strategies for ambulatory patients suspected to have deep vein thrombosis. We also calculated the incremental cost per additional life saved for each strategy. Our analysis revealed that the optimal approach was to perform real-time ultrasonography followed by anticoagulation therapy if deep vein thrombosis is found. This approach was both effective and cost saving compared with no testing or treatment. Serial follow-up studies of patients whose initial study suggested no DVT saved additional lives, but at a cost of $390,000 per each additional life saved for patients with one follow-up study and $3.5 million per each additional life saved for patients with a second follow-up study. Venography should play a limited role in the contemporary evaluation of patients suspected to have deep vein thrombosis. Future research should focus on the determination of clinical predictors of patients who should undergo serial examinations.

Anticoagulants↗
PubMed1991

Lipoprotein-cholesterol analysis during screening: accuracy and reliability.

OBJECTIVE: To evaluate the accuracy and reliability of lipoprotein-cholesterol measurements obtained during screening. DESIGN: Cross-sectional study. PARTICIPANTS: From November 1989 to January 1990, 154 adults were screened. MEASUREMENTS: Split venous samples from fasting participants were analyzed for total cholesterol, triglyceride, and high-density-lipoprotein (HDL) cholesterol with screening and standardized laboratory methods. Low-density-lipoprotein (LDL)-cholesterol levels were calculated using the Friedewald equation. Split venous samples from nonfasting participants were analyzed for total cholesterol. Capillary blood samples were analyzed for total cholesterol with the screening method. MAIN RESULTS: Total cholesterol measurements in screening venous blood samples were 5.4% and 3.8% lower than the laboratory values in samples from fasting and nonfasting participants, respectively. Triglyceride and HDL-cholesterol values in venous samples obtained from fasting participants were, on average, 9.8% and 11.2% lower than the respective laboratory measurements. Screening HDL-cholesterol values varied, differing from the laboratory values by as much as 40% in 95% of participants. In fasting participants, total cholesterol in capillary samples averaged 5.5% higher than in venous samples; in nonfasting participants the capillary samples were 3.1% higher. Screening for either total cholesterol or LDL cholesterol identified 93% of the persons with LDL-cholesterol values of 3.36 mmol/L (130 mg/dL) or higher. CONCLUSIONS: Total cholesterol can be reliably measured in samples from fasting or nonfasting persons. The values in capillary blood samples were slightly higher than those in venous samples. Screening HDL-cholesterol values were too variable to establish the HDL-cholesterol level reliably. Participants with high LDL-cholesterol levels were identified as accurately by measuring total cholesterol only when compared with calculating the LDL-cholesterol level from total cholesterol, triglyceride, and HDL-cholesterol concentrations.

Adult↗
PubMed1991

A cDNA encoding a human CCAAT-binding protein cloned by functional complementation in yeast.

We constructed a comprehensive cDNA library from HeLa cell mRNA in a vector that directs expression of the cDNA in Saccharomyces cerevisiae. We used this library to clone the human counterpart of the Sa. cerevisiae CCAAT-binding transcription factor, Hap2, by functional complementation of a hap2 mutation. The cDNA encoding the human Hap2 homolog encodes a protein of 257 amino acids that has a 62-amino acid carboxyl-terminal region 73% identical to the essential core region of Hap2. The amino terminus of the protein is highly enriched in glutamine residues, reminiscent of transcriptional activation domains of several other mammalian transcription factors. Analysis of human Hap2 expression reveals three major transcripts: a 4.1-kilobase species found in all cell types examined, a 7.0-kilobase species specific to B lymphocytes, and a 1.6-kilobase species that is expressed preferentially in HeLa cells and that likely corresponds to our cDNA clone. Thus, the human Hap2 homolog and related factors may play both a constitutive and cell type-specific role in gene expression. The general approach of cloning by complementation should allow the isolation of many human genes for which corresponding yeast mutations exist.

Amino Acid Sequence↗
PubMed1991

The status of restrictive smoking policies: a survey of medical schools in the United States and Canada.

All schools of medicine in the United States (N = 128) and Canada (N = 16) were surveyed by telephone to determine if they had instituted policies to restrict smoking. Some policy restricting smoking was reported by 80.56 percent of US schools (N = 103) and by 93.8 percent of Canadian schools (N = 15). However, only 52.3 percent of US (N = 67) and 56.3 percent of Canadian medical schools (N = 9) indicated they had formal written policy statements. Only 13 percent of US schools and 19 percent of Canadian schools had banned smoking totally.

Canada↗
PubMed1991

The yield of cholesterol screening in an urban black community.

BACKGROUND: While the distribution of cholesterol levels have been well studied in the general population, little is known about cholesterol and other cardiovascular disease risk factors in screenings held in an urban Black community. This study was designed to determine the yield of cholesterol screening in this community. METHODS: Screening took place in eight community sites. Serum total cholesterol was measured using a rapid capillary technique. Blood pressure was taken according to national guidelines and the average of two to three measurements were used. Standard interviews were used to determine the presence of cardiovascular risk factors by history. RESULTS: Of the 562 individuals screened, 44.9 percent had cholesterol levels requiring referral for follow-up care. Of those with total cholesterol greater than or equal to 6.21 mmol/L, 66.4 percent were previously undetected and more than half also had blood pressure levels greater than or equal to 140/90 mmHg on screening; 45 percent of all participants had blood pressure greater than or equal to 140/90 on screenings. Of those with a history of elevated total cholesterol levels, none had levels below 5.17 mmol/L at the time of screening. CONCLUSIONS: Multiple risk factors are highly prevalent in the urban Black community during cholesterol screening programs. Findings suggest the need for cholesterol programs incorporating blood pressure screening in the urban Black community.

Adult↗
PubMed1991

Technetium-99m-RBC venography in the diagnosis of deep venous thrombosis of the lower extremity: a systematic review of the literature.

We systematically reviewed the six articles from the English-language medical literature, since 1979, which compared 99mTc-RBC venography with contrast venography for the diagnosis of deep venous thrombosis (DVT) of the lower extremity. The studies were generally small in size and poorly compliant with methodologic standards for diagnostic test research. There was considerable variation in both how the 99mTc-RBC venograms were performed and how they were interpreted. Sufficient clinical information on the patients was not provided. Although the overall sensitivities and specificities were high with a mean sensitivity of 0.89 and a mean specificity of 0.84, the small numbers of patients resulted in wide 95% confidence intervals. For distal disease, with only a total of 14 patients studied, the 95% confidence intervals were particularly broad. Although 99mTc-RBC venography is a promising technique, future studies with larger numbers of patients and closer adherence to methodologic standards are required.

Erythrocytes↗
PubMed1991

Axillary and subclavian venous thrombosis. Prognosis and treatment.

To clarify the prognosis of axillary and subclavian deep venous thrombosis and to determine which clinical factors influence its sequelae, we systematically reviewed the English-language literature published on this subject since 1950. Seventy-one case reports and 17 case series describing a total of 329 patients met our inclusion criteria for detailed review. There were major deficiencies in the quality, as well as quantity, of the available clinical data: few patients were enrolled at axillary and subclavian deep venous thrombosis inception, and outcome assessments were susceptible to bias and based on insensitive diagnostic tests. Posttreatment symptoms were reported in 34% of cases, pulmonary embolism in 9.4% (one half documented by lung scan or angiography), and death in 1.2% (three of four deaths due to pulmonary emboli). These complications occurred regardless of etiologic category (spontaneous, catheter related, or miscellaneous). Thrombolytic agents and surgery, in addition to anticoagulation, were often used to treat axillary and subclavian deep venous thrombosis, but there were no controlled trials to support any one approach. Until such trials are performed, therapy should be based on the anticoagulation regimens proved to be effective for deep venous thrombosis of the lower extremity. In selected patients, thrombolytic therapy and surgery may have important roles.

Axillary Vein↗
PubMed1990

Functional status after coronary artery bypass grafting and percutaneous transluminal coronary angioplasty.

Two cohorts of consecutive patients of comparable age with similar preprocedure cardiac function who underwent either coronary artery bypass grafting (CABG; n = 106) or percutaneous transluminal coronary angioplasty (PTCA; n = 64) were entered into a prospective comparison study examining functional status and return to work during the first year of recovery. Patients were evaluated using standardized functional status instruments for activities of daily living, work performance, social activity, mental health and quality of social interaction at 1, 6 and 12 months after the procedure. Within the CABG group, statistically significant improvements of functional status on every subscale were noted over the 1-year follow-up. Patients undergoing PTCA demonstrated significant improvement in all dimensions except for the quality of interaction at 1 year as compared with baseline. When the 2 groups were compared, the PTCA group demonstrated greater participation than the CABG group in routine daily physical and social activities at 1 and 6 months, but this apparent advantage disappeared by 1 year. Measures of psychological functioning were better after CABG than after PTCA. A reduction in the number of those with employment occurred in both the CABG and PTCA groups, independent of physical functional status measures, which improved in both groups after the procedures. For those with employment, the CABG group reported the greatest improvement in work performance.

Activities of Daily Living↗
PubMed1990

Ending smoking at the Johns Hopkins Medical Institutions. An evaluation of smoking prevalence and indoor air pollution.

An empiric evaluation of a policy ending smoking in a large urban medical center was conducted. The study included a prospective cohort tracking of employees to measure changes in smoking behavior, environmental fires, smoking-related litter, and environmental tobacco pollution exposure. A 25% decrease in employee smoking prevalence was found (21.7% vs 16.2% before vs after policy implementation, respectively). The daily number of cigarettes reportedly smoked by employees who continued smoking and the total number smoked at work decreased across all occupational categories by an average of 25%. Significant reductions were noted in the level of public smoking and the amount of cigarette remnants. Nicotine vapor concentrations decreased significantly in all areas except restrooms. These findings suggest that visible smoking and environmental tobacco smoke exposure can be markedly decreased by instituting a policy eliminating smoking in a large medical center.

Air Pollutants, Occupational↗